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Rural surgical and obstetric facility-level outcomes for index procedures: a retrospective cohort study (2016-2021)
Jude Kornelsen1, Gal Av-Gay2, Anshu Parajulee2
1From the Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC (Kornelsen, Av-Gay, Parajulee, Stoll) and the Rural Coordination Centre of British Columbia, Vancouver, BC (Humber, Ebert, Skinner). jude.kornelsen@familymed.ubc.ca.
Rural surgical care in British Columbia is as effective as care at referral facilities for common procedures like colonoscopy, hernia repair, and appendectomy. Family physicians with enhanced surgical skills (FPESS) also provide comparable outcomes for low-acuity patients.
Area of Science:
- Rural Health
- Surgical Outcomes
- Health Services Research
Background:
- Rural communities face challenges accessing procedural care, raising concerns about the quality and safety of surgical services.
- Previous studies have questioned the efficacy of rural surgical care compared to larger referral centers.
Purpose of the Study:
- To compare adverse outcomes of common surgical procedures in rural British Columbia (BC) with those in referral facilities.
- To evaluate if family physicians with enhanced surgical skills (FPESS) achieve outcomes comparable to specialists for low-morbidity patients.
Main Methods:
- Retrospective observational study of patients undergoing colonoscopy, hernia repair, appendectomy, or cesarean delivery between 2016-2021.
- Risk stratification by comorbidity and multivariable Firth logistic regression to adjust for patient acuity and demographics.
- Comparison of FPESS outcomes with regional specialists for low-acuity cases, using adjusted odds ratios and noninferiority tests.
Main Results:
- Rural facilities demonstrated quality of care equivalent to referral facilities for colonoscopy, hernia repair, and appendectomy.
- FPESS achieved outcomes comparable to specialists for low-acuity patient procedures.
- Most rural procedures were performed by FPESS (34.9%) and visiting general surgeons (57.9%).
Conclusions:
- Evidence supports the efficacy of rural procedural care in BC facilities for specific low-acuity procedures.
- Findings highlight the potential for high-quality rural surgical care in similar settings.
- This study establishes benchmarks for rural surgical practice and outcomes.
